Provider Demographics
NPI:1528577400
Name:MEREDITH VENDER, LICENSED CLINICAL SOCIAL WORKER, PC
Entity Type:Organization
Organization Name:MEREDITH VENDER, LICENSED CLINICAL SOCIAL WORKER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:VENDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-975-5157
Mailing Address - Street 1:1180 S BEVERLY DR STE 608
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1158
Mailing Address - Country:US
Mailing Address - Phone:310-975-5157
Mailing Address - Fax:
Practice Address - Street 1:1180 S BEVERLY DR STE 608
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1158
Practice Address - Country:US
Practice Address - Phone:310-975-5157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-23
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health